Rheumatoid Arthritis: Personalized Treatment Approach Guided By MBDA Score

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MedicalResearch.com Interview with:
Karen Hambardzumyan
Research Assistant
Karolinska Institute
Department of Medicine, (ClinTRID)
D1:00, Karolinska University Hospital
Solna Stockholm

MedicalResearch: What are the main findings of the study?

Answer: One of the difficulties with rheumatoid arthritis (RA) treatment is unpredictable treatment outcome at the individual patient level. The course might be mild or severe independently of the therapy. To identify subgroups of patients who will benefit from specific therapy strategies is one of the goals for today’s rheumatologists. We have investigated a Multi-Biomarker Disease Activity (MBDA) score in patients from the Swedish Farmacotherapy (SWEFOT) clinical trial, where early rheumatoid arthritis patients were included/studied. The main finding was the usefulness of the MBDA score for prediction of those patients who will not get joint damage detected by X-rays (radiographic progression) during one year follow-up. This MBDA score, developed by Crescendo Bioscience (South San-Francisco, CA, USA) is based on serum levels of 12 different protein biomarkers and can categorize patients into 3 groups: patients with low, moderate and high disease activity. Ninety-seven percent of patients who had low or moderate MBDA score before treatment onset, did not experience radiographic progression during one year follow-up. This finding could contribute to a personalised approach to the RA patients for the optimal therapy choice.

MedicalResearch: Were any of the findings unexpected?

Answer: In multivariate analyses, when adjusted for confounders such as sex, symptom duration, baseline erosion, current smoking status and HAQ score, the MBDA score still showed significantly independent predictive capacity for the radiographic progression. Because the MBDA score was developed primarily as a measure of disease activity, we did not expect it to perform as well as it did for predicting radiological progression.

MedicalResearch: What should clinicians and patients take away from your report?

Answer: The MBDA score study shows one more time that rheumatoid arthritis is not a homogenous disease. Patients with similar clinical signs were shown to have different MBDA scores and to end up with or without joint damage, which suggest differences in the underlying pathogenesis. The mechanism of disease development is very different for different patients and laboratory analyses of biomarkers should go hand in hand together with clinical assessment.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Answer: Although low and moderate MBDA score could very nicely identify patients who will not develop radiographic progression, the prognosis for those with high MBDA scores remained variable. We are now studying these patients further to determine if measuring MBDA at multiple time points can have additional clinical relevance. We are also looking at the individual biomarkers comprising the MBDA score.

Citation:

Pretreatment multi-biomarker disease activity score and radiographic progression in early RA: results from the SWEFOT trial

Karen Hambardzumyan, Rebecca Bolce, Saedis Saevarsdottir, Scott E Cruickshank, Eric H Sasso, David Chernoff, Kristina Forslind, Ingemar F Petersson, Pierre Geborek, Ronald F van Vollenhoven

Ann Rheum Dis annrheumdis-2013-204986Published Online First: 8 May 2014 doi:10.1136/annrheumdis-2013-204986

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